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CAP Intake Form

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Disclosures

By submitting an online application, you acknowledge that you understand the following:

  • Thank you for contacting the Disability Rights Legal Center Community Advocacy Program’s intake line. The Disability Rights Legal Center represents individuals with disabilities who experience discrimination, mistreatment or harassment based on their disability.

  • Please note that we do not provide legal representation on the following types of cases: Criminal, employment, domestic violence, personal injury, consumer fraud, bankruptcy, evictions or foreclosures, applications or appeals for public benefits, wills/estates/trusts/conservatorships.

  • Completing this intake form will provide us with some necessary information regarding your situation. After you have completed this form, it will be reviewed by an attorney. We will then contact you within two to three weeks by phone or mail to accept your case or to provide you with appropriate resources and referrals, depending on your situation.

  • Any information that you provide is kept confidential.

Contact Information

Person with Disability (PWD)

(If you are contacting the CLRC on behalf of someone else)

Note: appropriate legal information and resources will be collected based on the city, county, and state of the person with disability. Please indicate if another location should be used in the memo section above.

Resources are often based on income level and providing accurate information will help us to provide resources that are the best match for you.

Everything disclosed is confidential. Even if you give us permission to use your statistical information for research purposes, none of your personally identifying information (name, address, phone, etc.) will be disclosed to anyone outside of the DRLC.

 

We cannot talk with you if you are represented by an attorney unless you obtain permission. Please fax, 213-736-1428, or email at drlc@lls.edu us your attorney authorization.   

Intake Information